| NPI | 1093822488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN CNP0474) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: MN CNP0474) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-07-21 |